What is the clinical evidence from this study?

Study design: Case Report. Population: Vasospastic angina (n=1). Intervention: Coronary angiography and intracoronary nitrate injection.

What question did this study set out to answer?

This case examines the diagnostic complexity of vasospastic angina in a young male patient presenting with chest pain.

June 14, 2026Indian Journal of Clinical Cardiology0 citationsOpen Access

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A Man in His Early 30s with Chest Pain and a Peculiar Coronary Angiogram

AAAndreas Y. AndreouUniversity of Nicosia

Key Result

Coronary angiography revealed right coronary artery spasm resolved by nitrates and an intercoronary communication that likely prevented ischemic electrocardiographic changes.

Key Points

This case examines the diagnostic complexity of vasospastic angina in a young male patient presenting with chest pain.
Patient underwent coronary angiography after reporting chest pain.
Intracoronary nitrate injection was performed to confirm spasm.
The presence of an intercoronary communication was evaluated during angiography.
Coronary angiography revealed diffuse stenosis of the right coronary artery resolved by nitrate injection, confirming spasm.
An intercoronary communication allowed bidirectional flow between the right coronary artery and the left circumflex artery.
The patient's history and angiographic findings complicated the diagnosis due to lack of ischemic electrocardiographic changes.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A man in his early 30s presenting with chest pain and suspected vasospastic angina.

Exposure

Coronary angiography with intracoronary nitrate injection

Outcome

Diagnosis of coronary vasospasm and identification of intercoronary communication

An intercoronary communication can provide protective bidirectional flow during coronary vasospasm, potentially masking ischemic electrocardiographic changes and making diagnosis challenging.

Abstract

We present the case of a patient with chest pain whose history suggested vasospastic angina. Despite the absence of ischemic electrocardiographic changes, the patient underwent coronary angiography, which showed no atherosclerotic lesions but a diffuse stenosis of the right coronary artery that was resolved promptly by intracoronary nitrate injection, therefore confirming spasm. Angiography also showed a straight vessel in the posterior atrioventricular sulcus, which was recognized as an intercoronary communication that connected the right coronary artery with the left circumflex artery and enabled bidirectional flow. The intercoronary communication likely served to partially protect the right coronary artery-dependent myocardium from ischemia during spasm. This case highlights the significance of a detailed history in constructing an investigation plan in order to make the correct diagnosis. By precluding concurrent ischemic electrocardiographic changes, the intercoronary communication made the diagnosis more challenging.

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A Man in His Early 30s with Chest Pain and a Peculiar Coronary Angiogram

Key Result

Key Points

Study Design

Structured PICO

Abstract

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